EP0568552A1 - Endoprothese, en particulier de l'articulation de la hanche. - Google Patents

Endoprothese, en particulier de l'articulation de la hanche.

Info

Publication number
EP0568552A1
EP0568552A1 EP92901853A EP92901853A EP0568552A1 EP 0568552 A1 EP0568552 A1 EP 0568552A1 EP 92901853 A EP92901853 A EP 92901853A EP 92901853 A EP92901853 A EP 92901853A EP 0568552 A1 EP0568552 A1 EP 0568552A1
Authority
EP
European Patent Office
Prior art keywords
cone
bone
axis
socket
endoprosthesis
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
EP92901853A
Other languages
German (de)
English (en)
Other versions
EP0568552B1 (fr
Inventor
Heinz Winkler
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Individual filed Critical Individual
Publication of EP0568552A1 publication Critical patent/EP0568552A1/fr
Application granted granted Critical
Publication of EP0568552B1 publication Critical patent/EP0568552B1/fr
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3601—Femoral heads ; Femoral endoprostheses for replacing only the epiphyseal or metaphyseal parts of the femur, e.g. endoprosthetic femoral heads or necks directly fixed to the natural femur by internal fixation devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/74—Devices for the head or neck or trochanter of the femur
    • A61B17/742—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck
    • A61B17/746—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck the longitudinal elements coupled to a plate opposite the femoral head
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30576—Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30576—Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs
    • A61F2002/30578—Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs having apertures, e.g. for receiving fixation screws

Definitions

  • Endoprosthesis especially the hip joint
  • the invention relates to an endoprosthesis, in particular of the hip joint, with an anchoring part which can be anchored to the bone and which is connected to a joint part. Endoprostheses are implanted when a satisfactory therapeutic result can no longer be achieved through joint-preserving operations. In the case of a hip joint, this is particularly the case if there is advanced coxarthrosis, femoral head necrosis or a medial fracture of the femoral neck.
  • abrasion causes serious defects which make a new __ la ⁇ t_ ⁇ t_f ____ ie__r ⁇ g extremely difficult or even void.
  • hip endoprostheses only the femoral head and neck are removed in some cases and replaced by a head prosthesis.
  • the anchoring part generally consists of a spit made of metal, for example titanium, which is fixed in the femoral medullary cavity and is provided with a laterally projecting pin, the free end of which carries a head part.
  • the skewer is then cemented in the femoral medullary cavity with polymethyl ethacrylate or hammered in without cement, in the latter case primarily an optimal contact between the bone and the implant is required, which can optionally be strengthened by secondary ingrowth of new bone tissue.
  • a joint prosthesis is known from DE-A 28 45 231, in which a joint part is provided with a shaft which is clamped to the bone with the aid of a lag screw.
  • DE-A 30 17 953 discloses an endoprosthesis for a femoral head, in which the head part is rigidly and immovably connected via a screw bolt to an anchoring part, which consists of a sleeve inserted into the bone and a trochanter plate screwed to the outside of the bone.
  • the screw bolt acts as a tie rod, by means of which the prosthesis on the bone is held under tension.
  • DE-A 3420035 describes a joint prosthesis in which the joint head is rigidly clamped to the bone via an extension.
  • Anchoring the prosthetic head in the shaft area is not only unphysiological, but also not technically easy. An extensive additional instrument is usually a prerequisite for an exact preparation of the bone. Furthermore, the opening of the medullary canal always results in violent and prolonged bleeding, which always necessitates the repeated administration of preserved blood.
  • the object of the present invention is to avoid the disadvantages mentioned and to create an endoprosthesis which is able to adapt in a controlled manner in particular to possible changes in the bone later on.
  • the invention proposes, starting from an endoprosthesis of the type described in the introduction, that the anchoring part or the joint part has a tubular guide and the other of these two parts has a rod-shaped sliding part which is in the tubular form - reduce guidance in the direction of the physiological flow of force is slidably arranged.
  • the inventive design of the endoprosthesis thus ensures that the glen part can be displaced relative to the anchoring part in a precisely predetermined axial direction, namely in the direction of the physiological flow of force, during the entire period in which the geoprosthesis is functioning. Basically, two advantages are achieved.
  • this guided displaceability enables axial repositioning in the case of localized bone degradation, so that the stability of the prosthesis is maintained for a practically unlimited period after implantation, whereas the known prostheses are at risk of being altered in the living bone as a result of reconstruction processes completed healing of the prosthesis loosens it or no longer assumes its optimal position, on the other hand it is ensured that the prosthesis according to the invention adjusts itself automatically in an optimal manner and thus an optimal load distribution between the prosthesis and the bone is ensured.
  • the anchoring part only a subordinate takeover of power flows takes place in the design according to the invention. Rather, as with the natural joint, these force flows take place through the preformed bone structures.
  • the head prosthesis according to the invention with an anchoring part which can be anchored to the femur and which is connected via a neck part to a head part fastened thereon is characterized in that the neck part is connected to the rod-shaped sliding part which is connected in a tubular guide connected to the anchoring part is arranged essentially displaceable in the direction of the femoral neck axis, and which is provided with a shoulder adjacent to the femoral neck.
  • the attachment securely anchors the prosthesis to the femur without having to remove large amounts of intact bone material.
  • the surface of the attachment lying on the femoral neck is conical. frustoconical, the tip of the cone is directed laterally distal and the axis of the cone coincides with the axis of the rod-shaped sliding part.
  • the tip angle of the cone is expediently between 135 ° and 140 °. This ensures that the contact surfaces of the approach with the bone are essentially perpendicular to the preformed trabecular structures in all proportions. This also ensures that the anatomically predetermined relationships between the CCD and AT angles are maintained after the prosthesis is supplied. The power transmission is therefore largely physiological via the naturally predetermined structures.
  • the neck part has a cone arranged centrally of the frustoconical projection, the axis of which essentially coincides with the axis of the femoral neck and is inserted into a conical recess in the head part.
  • the tubular guide which penetrates the femoral neck essentially in the direction of the femoral neck axis and in which the sliding part is displaceably guided.
  • the anchoring part is not anchored in the medullary canal, long-lasting bleeding from the medullary canal is avoided, as a result of which the administration of blood preserves is significantly reduced, if not unnecessary.
  • the anchoring part is easy to remove and an infection process cannot spread over the entire thigh, which is why an immediate reimplantation of another prosthesis is associated with a significantly lower risk.
  • This embodiment also has the advantage that if the endoprosthesis according to the invention fails, the replacement thereof by a known prosthesis can be carried out without any problems as in a primary operation, since no defects were set on the required bone substance during the implantation of the endoprosthesis according to the invention.
  • the acetabular prosthesis according to the invention is, based on a known socket anchored in a milling of the pelvic bone, which is provided on its cranial edge with at least one flap which can be connected to the pelvic bone via fastening means, characterized in that at least two are attached to the or the tab (s) connected tubular guides are provided, the axes of which run perpendicular to the socket entrance plane, and which are penetrated by screws which form or have rod-shaped sliding parts which can be anchored to the pelvic bone and which are arranged displaceably relative to the pipe-shaped guides.
  • This embodiment also ensures that if the bone structure changes due to the displaceability, the socket can be axially adjusted, but it cannot tilt or rotate, so that the stability of the prosthesis is maintained at all times even in cases of localized bone loss without the Force flow between the prosthesis and the bone is disturbed or interrupted. Even in the event of any settlement process, all parts of the ladle circumference are thus exposed to an even load distribution. In contrast, there is a risk of tipping over in the known acetabular prostheses, as a result of which the flow of force is disrupted. Furthermore, this design enables the pan to be displaced perpendicular to the pan entrance plane after the screws have been placed, but at the same time secures the pan against tilting and rotating movement.
  • the screws have a central, threaded anchoring section and a peripheral, so that the threading of the screws in the direction of the screw axis is not impeded. slidably guided in the associated sliding sleeve.
  • Fig.l shows a total endoprosthesis of the hip joint
  • Fig.2 shows a view of the acetabular prosthesis in the direction of arrow II in Fig.l.
  • the total hip endoprosthesis shown has a head prosthesis 1 and a socket prosthesis 2.
  • the head prosthesis 1 consists of a head part 3, which is placed on a cone 4.
  • the cone 4 is connected to a shoulder 5 which has a truncated cone-shaped surface 6 which bears against a recess in the femoral neck 7 produced by milling.
  • the tip of the cone is thus directed laterally distally, the axis of the cone substantially coincides m the axis 8 of the femoral neck 7 together.
  • the tip angle e-L of the cone is approximately 135 ° to 140 °, so that the surface 6 of the projection 5 is approximately perpendicular to the preformed trabecular structures.
  • the cone 4 and the shoulder 5 together form a neck part which is connected to a rod-shaped sliding part 9 starting from the tip of the cone and which is displaceably guided in an anchoring part 10 in the direction of the femoral neck axis 8.
  • the anchoring part 10 has a sleeve 11 which is inserted into a bore of the femoral neck 7 which runs in the direction of the femoral neck axis 8 and is open laterally distally.
  • the sleeve 11 is connected to a plate 12 which is provided with holes through which screws 14 screwed into the femur 13 are passed.
  • the socket prosthesis 2 consists of a spherical cap
  • Pan 15 made of a metal of high biocompatibility, for example made of titanium, which is provided with conventional holding devices 16 for the stable insertion of an inlay 17 made of lubricious material, for example made of polyethylene.
  • the pan 15 is connected at its cranial edge to two tabs 18, each of which has a sliding sleeve 19, the axes of the sliding sleeves being perpendicular to the pan entrance plane 20.
  • each tab 18 can also have two or more sliding sleeves 19 penetrated by the screws 21 and it is also possible) to provide only a single tab with at least two sliding sleeves 19.
  • the screws 21 passing through the sliding sleeves 19 are fixed in the acetabulum.
  • the screws 21 have a central, threaded anchoring section 22 and a peripheral sliding section 23, which is displaceably guided in the sliding sleeves 19.
  • This arrangement ensures that the socket 15 is fixed against tilting and twisting, but enables the axial axes to be adjusted in the case of localized bone removal, while the screw axes are perpendicular to the socket entry plane 20, while maintaining stability.
  • the resection plane being to be as perpendicular as possible to the femoral neck axis 8.
  • a central drilling wire is placed in the direction of the femoral neck axis 8, which penetrates the entire femoral neck 7 and emerges material from the femur 13. The central position of the wire can be ensured by means of a target device or by means of an X-ray control (image converter).
  • a multi-stage drill is drilled from laterally over the horizontal drill wire, so that a larger diameter hole for receiving the sleeve 11 of the anchoring part 10 and a smaller diameter hole is formed for receiving the sliding part 1.
  • the angle between the borehole and the femoral shaft is measured.
  • the anchoring part 10 is selected, inserted and fixed on the femur 13 by means of the screws 14.
  • the preparation of the receiving surface for attachment 5 is then carried out from the medial side. This is done by means of a frustoconical rasp, the shape of which corresponds exactly to that of the projection 5 and which is provided at its tip with a guide rod which is inserted into the sleeve 11 already inserted.
  • the preparation is carried out until all cortical edges of the femoral neck stump are smoothed.
  • the pan bed is then prepared using a conventional hemispherical rasp, the diameter of which should correspond to the largest diameter of the acetabulum.
  • a trial pan of the same shape is inserted into the created bed, which is provided on its cranial edge with at least two guide bushes perpendicular to the plane of the pan entrance for receiving a drill.
  • the drill holes for receiving the screws 21 are made through the guide bushings.
  • the trial prosthesis is removed and the length of the drill holes is measured. By means of a countersink drill of constant drilling depth, the boreholes are expanded in their peripheral portion to accommodate the sliding sleeves 19 of the acetabular prosthesis 2.
  • the now prepared head prosthesis 1 is inserted from the medial side with the sliding part 9 first into the bone bearing created for it and firmly attached.
  • the peripheral end of the sliding part 9 should then end approximately with the lateral outlet opening of the sleeve 11.
  • the head part 3 is repositioned in the Pfannen ⁇ prosthesis 2, the implantation is completed.
  • a hip endoprosthesis is shown in the drawing, the invention can in principle be used with the same advantages for the prosthetic restoration of other joints, in particular the knee joint.
  • the anchoring part is implanted in the form of a sliding sleeve in the femoral or tibial shaft.
  • a preferably rod-shaped sliding part is slidably guided, which is firmly connected to the femoral or tibial joint part of any design.
  • the humeral anchoring part is attached to the lateral side of the humerus in the same way as for the hip joint.
  • a preferably rod-shaped sliding part is slidably guided, which is firmly connected to a spherical cap-shaped joint part.
  • the glenoid prosthesis part expediently consists of a sleeve-shaped anchoring part which is fastened in the shoulder blade and in which a preferably rod-shaped sliding part is slidably guided, which is firmly connected to a shell-shaped joint part.

Landscapes

  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)
  • Steroid Compounds (AREA)
  • Pressure Welding/Diffusion-Bonding (AREA)
  • Ceramic Products (AREA)

Abstract

Une endoprothèse pour une articulation de la hanche se compose d'une prothèse de tête (1) et d'une prothèse de cotyle (2). La partie de tête (3) dans la prothèse de cotyle (2) est reliée par une pièce rapportée (5) dont la surface tronconique (6) est disposée contre le col (7) du fémur. De la pièce rapportée (5) part, dans le sens latéral et distal, un élément coulissant (9) en forme de tige qui se déplace dans une douille (11) qui est reliée à une plaque (12) fixée sur le fémur (13). La prothèse du cotyle (2) se compose d'une pièce en cotyle (15) qui est reliée, au niveau de son extrémité dirigée vers la tête, à une attache (18) d'où partent des douilles coulissantes (19) dont les axes sont perpendiculaires au plan de l'entrée du cotyle. Des vis (21) traversant les douilles coulissantes (19) permettent une fixation dans l'os.
EP92901853A 1991-01-25 1991-12-23 Endoprothese de l'articulation de la hanche Expired - Lifetime EP0568552B1 (fr)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
AT167/91 1991-01-25
AT0016791A AT398529B (de) 1991-01-25 1991-01-25 Endoprothese, insbesondere des hüftgelenkes
PCT/AT1991/000139 WO1992012691A1 (fr) 1991-01-25 1991-12-23 Endoprothese, en particulier de l'articulation de la hanche

Publications (2)

Publication Number Publication Date
EP0568552A1 true EP0568552A1 (fr) 1993-11-10
EP0568552B1 EP0568552B1 (fr) 1994-10-05

Family

ID=3483350

Family Applications (1)

Application Number Title Priority Date Filing Date
EP92901853A Expired - Lifetime EP0568552B1 (fr) 1991-01-25 1991-12-23 Endoprothese de l'articulation de la hanche

Country Status (8)

Country Link
US (1) US5376125A (fr)
EP (1) EP0568552B1 (fr)
JP (1) JP3325889B2 (fr)
AT (2) AT398529B (fr)
AU (1) AU9114591A (fr)
CA (1) CA2101249C (fr)
DE (1) DE59103190D1 (fr)
WO (1) WO1992012691A1 (fr)

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JPH06504457A (ja) 1994-05-26
JP3325889B2 (ja) 2002-09-17
AT398529B (de) 1994-12-27
AU9114591A (en) 1992-08-27
CA2101249A1 (fr) 1992-07-26
CA2101249C (fr) 2003-09-16
DE59103190D1 (de) 1994-11-10
EP0568552B1 (fr) 1994-10-05
US5376125A (en) 1994-12-27
WO1992012691A1 (fr) 1992-08-06
ATA16791A (de) 1994-05-15
ATE112474T1 (de) 1994-10-15

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